Innovation that Works

When the Affordable Care Act (also known as Obamacare) was
passed into law there were those who liked it and those who didn’t. There were,
however, some parts of the law that people on both sides liked. One of those
parts that found a large following of fans was the creation of the Center for
Medicare and Medicaid Innovation (CMMI).

CMMI was set up to be a petri dish for trying out new and
more efficient ways to administer health care. To do this, CMMI was allowed to
be free of many government regulations, use ideas from many sources, sign up
providers who wanted to try out these new approaches and carefully analyze the
results. What a great idea . . . rather than the government overhauling a huge
part of a health care process with an untried approach and the accompanying
unintended consequences, you could run a test, see what works and what doesn’t
and then take the proper steps to implement the tested approach.

CMMI tests were intended to be small and specific and to
have a definite end. They were tasked to be well planned with well-defined
criteria for success. This program was a new and powerful tool, and as it grew,
it began to be used beyond its original intent. Rather than a testing platform it
was used, in some instances, to implement nation-wide changes to Medicare and
Medicaid, without Congressional oversight. Both the Obama administration and
the Trump administration used CMMI to make some test programs permanent, effectively
changing the health care system without Congressional approval. This was done
by making the size of the test large, so it impacted a large swath of the
nation or by having a very fast phased rollout, faster than the results of the
initial test could be effectively evaluated. They also made provider
participation mandatory to ensure large participation. All of these approaches
went way beyond the basic intent of the CMMI.

While this approach was a great way to quickly initiate
change, it avoided the checks and balances of both the judicial and legislative
branches of the government. The most egregious of these tests were opposed by
patients and providers alike and these groups were often successful in stopping
the widespread adoption of the changes, but it became evident that legislation
was needed to ensure that the constitutional checks and balances were
maintained.

Congress has acted . . . legislation has been created and introduced
in the House. The Bill, HR 5741 (IH) – Strengthening
Innovation in Medicare and Medicaid Act, (a bi-partisan effort) mandates
that certain “rules of the road” must be in place to ensure that any tests have
a defined duration and that any final changes to our health care system are put
in place with Congressional approval.

CMMI is a powerful tool that can have both good and bad
impacts on our access to quality health care. This new legislation will
establish safeguards that will ensure CMMI stays within the initial intent of
the program. It will protect both providers and patients and will allow
innovation to be implemented within the checks and balances of our government.

I will keep you apprised of its progress and urge you to
encourage your Senators and Representative to support this legislation.